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KNDU: MBBS for the rich, crumbs for the poor

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By RAMYA KUMAR

A regular day at work. A medical student, Niluka (not her real name), comes to my office to discuss the presentation she is due to make at a research symposium. In the middle of our meeting she is in tears. Her mother, a single mother, who works as a security guard in remote Polonnaruwa, cannot afford her boarding fees as she has to cover her sister’s A/L tuition classes, as well as her brother’s medicines for a recent health issue. Niluka is unable to focus on her presentation because she is worried about her financial situation. She has a year and half to go.

This is the picture of Free Education that many do not see, of students struggling to make ends meet. Such stories are commonplace at our non-fee levying state universities; as Sumathy Sivamohan wrote recently, “free education does not serve everybody equally, but over the years and across decades, it has come to represent the hope of a vast majority for a better place in society.” However, this aspect of Free Education is obscured by images of protesting students “wasting tax-payers’ money,” constructed by the media in the service of the state. While Colombo-based elites (and others) may be duped into seeing the Kotelawala National Defence University (KNDU) Bill and military repression as solutions to the problems in higher education, this article explores what the Bill really means, especially its implications for medical education.

No vision, no imagination

Free Education, despite its marginalisations and exclusions, is etched in our nation’s consciousness, so much so that governments have been reluctant to overtly dismantle the public education system. Instead, they have stealthily underfunded the system, while incentivising expansion of private education. With inadequate public investment, the state universities under the UGC are floundering to service demand, while the fee-levying Kotelawala Defence University (KDU) and non-state fee-levying higher educational institutions, such as SLIIT, receive state subsidies to finance infrastructure as well as student loans.

Fee-levying universities are simply not affordable for the vast majority in this country. To flourish, they require public-financing, both for their establishment and for student loans, to make them accessible to the masses. While escalating investment in KDU and private fee-levying universities through public funds, the government has adopted a zero-investment policy for state universities under the UGC and increased admissions by a third, this year. The fallout of increasing admissions without budgetary allocations is most felt by universities in peripheral districts, already running on meagre resources.

A government’s vision for education is inextricably linked with its economic policy. While lacking a credible vision for education, successive governments have been equally unimaginative in attempts to improve the economy. Sri Lanka relies on imports for day-to-day essentials, such as lentils, pulses, and milk, with little investment in agriculture or agro-industries for value addition. Meanwhile, billions of rupees are lost in tax incentives to attract (elusive) foreign direct investment, including in education. The Board of Investment expanded its purview to include the social sector in the 1990s, essentially opening education to the global market. The latter has changed the landscape of education in the country with international schools, private colleges and other higher education institutions proliferating in the decades since, and creating parallel systems of education for students from rich and poor families.

Enter KNDU

Faced by mounting debt, the government is desperately looking for avenues to build up its foreign reserves. In 2019, the incumbent government proposed a “free education investment zone” to attract investment from “top international universities,” with accompanying tax exemptions, yet another scheme to subsidise the private sector through public funding. With COVID-19, the plans for the investment zone fell by the wayside. However, just a few years after the SAITM debacle, the government is once again looking to expand private medical education, this time through the KDU.

In 2019, the incumbent President’s manifesto, which is the government’s policy framework, stated that “steps will be taken to expand the Kotelawala Defence University” (p.22). Why KDU? Because the majority of its students are enrolled on a fee-levying basis through mechanisms outside the UGC’s Z score-based system. Although seemingly catering to the military, a closer look at the statistics presented on the website of KDU’s Faculty of Medicine, indicate that the number of medical students recruited doubled, and then tripled, once the faculty began to enroll “non-military foreign students.” As recruitment was limited to foreign students, albeit loosely defined, KDU did not encounter too much controversy.

The KNDU Bill proposes to build a parallel militarised university system, and alternatively, a change to the Universities Act of 1978 aims to bring KDU under the purview of the UGC, as a university for a “specific purpose.” Clearly, the appeal of KDU and other “specific purpose” universities is not their potential to strengthen Free Education. That these reforms will increase the military’s involvement in higher education has been the focus of debate in recent weeks, but less attention has been paid to their implications for education opportunities for students like Niluka, and their potential impact on medical education.

‘MBBS Kada’

Both the proposed KNDU Bill and the amendment to the Universities Act can be viewed as attempts to create the conditions for the expansion of fee-levying MBBS degree programmes, which have been resisted since the days of NCMC. The KNDU Bill will give legal authority for KNDU to recognise and affiliate other institutions to KNDU, bypassing the UGC as well as the Sri Lanka Medical Council’s minimum standards. The Bill will ultimately result in the proliferation of poorly regulated ‘MBBS kada,’ and a decline in the overall standards of medical education.

Even the Association of Medical Specialists (AMS), a body not averse to private education, has made the following statement regarding the KNDU Bill: “On principle, the AMS is not against quality fee levying medical education…if it is regulated and monitored by the UGC and the Sri Lanka Medical Council. However, lack of proper process and transparency will prevent the establishment of such fee levying institutions in Sri Lanka.”

Could expanding medical education in this manner present opportunities to address problems in the health sector, such as the regional maldistribution of physicians?

First, if KNDU and its affiliates aim to attract international medical students, it is unlikely that these graduates would serve in Sri Lanka.

Second, as the Bill will enable KNDU to admit local students, if we assume the current fee structure of upwards of Rs. 1 million per year for the MBBS programme, the KNDU medical students would represent the elite who are more likely to immigrate to greener pastures.

Third, if the government intends to broad-base MBBS degree programmes, they would need to offer hefty student loans to our students. Evidence from other countries suggests that medical graduates with student loans are more likely to opt for higher paying specialties rather than work in primary care, and less likely to serve in rural areas.

It is therefore unlikely that the KNDU Bill would contribute towards advancing the health sector, except perhaps through its military cadets, who would most likely work for the Ministry of Defence and not the Ministry of Health.

Student loans may have other unintended consequences. Despite private practice being widespread, many doctors, especially women non-specialist doctors, do not engage in private practice. In fact, general doctors from peripheral districts often do return to their districts, although they may remain in urban centres owing to the poor education facilities available to children in remote rural areas. These doctors make up the physician workforce in base hospitals and above, as well as in the preventive sector, in all parts of the country. Having to repay a student loan may drive such doctors to remain in districts, where private practice is more available and lucrative, intensifying the regional maldistribution of physicians.

Crumbs for the poor

What of students like Niluka in the non-fee levying state university system? A quick perusal of the website of KDU’s Faculty of Medicine indicates that brain drain may have already commenced. Imagine the fate of our non-fee levying state medical faculties with the mushrooming of ‘MBBS kada’ across the country? They will inevitably offer higher salaries, as does KDU, attracting without any outlay teachers whose training was subsidised by state universities. Furthermore, as reported in the media, KDU has already seen massive state investment, much of it in its teaching hospital, far beyond investments in any single university or faculty of medicine under the UGC. The fate of medical education at non-fee levying state universities does not need to be spelled out here. With their weakening, the demographics of students who enter medicine are sure to change, with fewer and fewer opportunities for students like Niluka, not to mention the broader implications for medical education and the healthcare system.

Let’s stand together to protect Free Education and Free Medical Education!

 

(The writer is attached to the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna).



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Opinion

We are tired of politicians’ sick jokes

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By Dr. Sarath Gamini De Silva

The country is in dire straits. The economy is almost bankrupt, the pandemic is still on a deadly rampage, children have been denied schooling for nearly two years, and starvation of the populace is imminent. The politicians appear to be on a mission to enrich themselves, planning to make the best use of the opportunity, making hay while the sun shines. All systems are in place for those who fleeced the country over the years to prosper further.

Many businessmen, mostly cronies of those in power, are exploiting the misery of the people and profiteering from the pandemic. Some in tourism and related-travel industry, hoteliers, importers of pandemic-related material like testing equipment and drugs, others in private healthcare and importers and wholesale dealers of essential food items seem to be making more money than during normal times. This is when large sections of the populace are struggling to make ends meet on a daily basis. How in a predominantly Buddhist country, mostly Buddhist businessmen, let alone equally errant non-Buddhists, do not appear to believe in Kamma and keep on accumulating wealth, exploiting the misery of the people, with a ‘we shall never die’ attitude, is really depressing. In the apparent absence of legal provisions or lack of willingness of the authorities to apprehend the culprits, the masses are just hoping and praying that the effects of Ditta Dhamma Vedaniya Kamma will catch up to them sooner than later.

In the middle of all this, many politicians of all hues compete among themselves to amuse people with miserable jokes. Several ministers habitually give hilarious evasive answers to questions raised about important matters, thus exposing their gross ignorance of the subject. A suggestion was offered that mass scale deaths of fish, turtles and other marine life along the coastline after the recent fire in a sinking ship was just an expected seasonal phenomenon. Yet another minister talking of the same ship thought that rather than attempting to douse the fire, it would be far more profitable to let it burn out fully so that millions of dollars could be collected as compensation. Another, a medically qualified minister, claimed that the price of drugs was raised to prevent patients from hoarding drugs at home. He also blamed the National Medicines Regulatory Authority (NMRA), the authority responsible, for delaying the vaccination programme by wasting too much time examining the documents without summarily approving the vaccines. Yet another parliamentarian, a lawyer by profession, suggested that the disorderly vaccine rollout was probably as instructed by the ‘donor’ country. A politician thought it was a good idea to bring in tourists from a country ravaged by COVID-19 to test how the disease would spread in our country. Another famously questioned why we need atmospheric oxygen at all while defending the wanton denudation of the land of vegetation. A former parliamentarian boasted of the leader of his party being accepted worldwide as a great man soon after he was totally rejected and reduced to a non-entity by the local electorate.

Another classic example is the recent gazette notification of over 600-strong list of items that will be discouraged from being imported. There are many items listed therein, a shortage of which could seriously affect the economy and could bring many industries to a standstill. However, the politicians have given full attention to lingerie. Even the Minister of Trade hurriedly summoned a press conference along with some garment manufacturers to reassure that the country is self-sufficient in underwear. The Opposition too probably fell into the trap laid by the government to divert attention from more important items therein and started making fun out of the lingerie issue totally ignoring the much more serious aspects of import restrictions. There seems to be a bunch of designated official jesters on both sides fully entrusted with entertaining the people with sick jokes. They turn every important discussion into a huge laughing matter, insulting the intelligence of the people. Even social media are full of such meaningless banter with hardly any serious discussion on matters of vital importance.

Thus in many instances being academically qualified does not seem to dampen their penchant for speaking falsehoods with ridiculous humour. The glaring lack of common sense among the representatives of the people is alarming. The general assumption seems to be that people are fools who will believe anything uttered by self-serving politicians. Unfortunately, this notion appears to be true for a significant segment of the electorate. At present, politicians are not accountable for their deeds and words. Ideally, party leaders or party whips should have some control over their utterances.

It is the general impression that the incumbent government elected, with an overwhelming mandate, is falling short in fulfilling many promises given. Hence it is high time that those offering themselves to the people as a viable alternative got their act together to convince the electors that they are a different lot capable of performing better than what has been happening for over 70 years. For those who had been in power earlier with nothing much achieved to boast about, this is going to be an arduous task. The people have lost faith totally in politicians, including the so-called educated ones (viyathun) who have proved to be mere treasure hunters no better than the rest, or even worse as they have no experience in governance. Perhaps the civil society activist groups should come to the forefront, to save us all from impending disaster.

Ideally, all parties or groups aspiring to gain power should have a long-term development plan. There should be designated spokesmen already academically qualified or have developed an in-depth knowledge in individual subjects like economy, finance, trade, healthcare, agriculture, industries and foreign affairs. Being a practising democracy, at least in name, all should be knowledgeable and free to express their views on various issues to some extent. However, those designated as above should take over when a crisis develops in a particular field so that the electorate can take part in a learned discussion and arrive at sensible conclusions. It is worth considering whether the concept of a shadow Cabinet as seen in advanced democracies could be adopted here so that if and when they come to power, they know exactly what their mandate and targets would be.

Politicians trying to surpass each other as jesters entertaining people with meaningless rhetoric will reduce the intensity, urgency and importance of the issues, making a mockery of the discussion. Concerted action is essential for a course correction the nation urgently needs to stall its rapid descent into oblivion.

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Opinion

Keep up with your record of service

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Letter to PM Mahinda Rajapaksa:

Dear Comrade, As I am sure you would recall, it was over 50 years ago that we first met, when you were making your first successful run for Parliament, and I was tallying the vote count for Beliatta.

I have been impressed by your commitment, from early days, to justice in the land of Palestine, a subject to which I, too, have drawn attention from time to time.

Though we have met occasionally in the intervening years, it was only in the mid-1990s that I actually worked with you, when you were the Minister of Labour and Vocational Training. The hostility that the then Prime Minister had towards you, happened to cover her view of me as well, and you decided to have me develop the infrastructure for our technical education system. Among the outcomes of that, credit for which should be shared by you, are the revision for the first time of the course materials (all in English and in a dialect favoured by foreign experts) that the National Institute of Technical Education provided our Technical Colleges, and making them available in Sinhala for the use of lecturers and students alike. It was also during that period that Parliament was offered the opportunity of debating at length and of endorsing the compendium of Labour Laws that were , and still are, applicable here.

I mention such matters as elements of what would be remembered long after your passing.

Needless to say, there are more spectacular achievements during your stewardship, not least among them the protection of our country from terrorists, trained and armed by India and ensuring their ultimate defeat.

The common theme of such development of our resources, as was encouraged by you, had to do with their protection for future use by the generations to come.

You also showed from time to time an instinctive gift for recognising the strength of the public services, and the skills required for putting them to optimal use.

Looking around now, what we see are attempts at destroying our resource base not only in land, water, minerals and the like, but as importantly our human resources – those in regular employment in whatever sector including the self-employed. Critical to that of course is that we continue to control the resources on which our agriculture, manufacturing industries and fisheries rely. General education is seen as the linchpin in all this but, as you were able to perceive some three decades ago, we need to invest more on developing teaching skills and facilities for practical training in the broad area of technical education.

I also write to draw your attention to the spectacle of some Ministers in your administration, erupting from time to time with highly misleading statements that target public institutions, including the personnel in the public services.

Some months ago, it was said that we spend more on our postal services than we earn. (Where in the world is it different? – the postal service is just that, a service provided for the people by the State). Such statements show that what is being targeted is not the postal service but the ‘real estate’ required by it.

Mr. Prime Minister, there are as you would know or suspect, a whole badawela of tendentious statements issued by some of your Ministers that would lead to or themselves constitute acts of treason against our country. To put it in short-hand, one is ‘tourism’. It continues to take away our sea shore from our people. It is given a whole slew of subsidies (paid for by our people) and no guarantees of it bringing in “VFE” – Valuable Foreign Exchange) or any scrutiny of how much. And, after all our contributions to making tourists and their service providers grin from ear to ear, we the State gets much less VFE than our expatriate workers send in each month.

Another is ‘plantations’. But the fact is that company owned plantations in Nuwara-Eliya and adjacent districts produce only a fourth of our tea – the bulk is produced in small holdings in the Galle, Matara, Kalutara and Kegalle districts.

A few days ago, the sale or lease of over 4000 acres in the hill country (that was denuded of much of its topsoil by the plantation industry) for raising cattle was announced. We the people have not been told who the beneficiaries of such largesse are or how they were chosen. The conditions attached to the deals have been kept secret. It does not seem to matter to such decision makers / decision takers, that the farming communities that were hounded out by the British lusting for what was once among the richest lands in the country, remain locked into ravines.

There are moves to bring in large machinery to crush our rock for export.

All such moves could be brought under control through, say, by small groups of MPs who possess the capacity to brief themselves.

Comrade, as you and I understand, the 50 years we have known each other is a tiny sliver of time. How you are remembered may not be in your hands, but it would be good to reflect on the saying that suggests that we should bear in mind the good that people have done, and bury the rest with their bones.

As time passes it would give perspective to recall Gautama’s words on the state of all life: jati-jara-marana.

With warm good wishes.

GAMINI SENEVIRATNE

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Opinion

Yohani – not our Manike?

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It is very heartening to hear that both the Prime Minister and the Opposition Leader of India have expressed their appreciation of the song Manike mage hithe, sung by the local artiste Yohani de Silva, which had gone viral in this part of the world.

Sadly, neither the government nor the Opposition bigwigs of Sri Lanka have congratulated her in the media, taking into consideration the vast amount of foreign exchange she is bringing into this country.

Indrasena Samaratunga

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